To describe the design of the Feel4Diabetes-intervention and the baseline characteristics of the study sample.
School- and community-based intervention with cluster-randomized design, aiming to ...promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes among families from vulnerable population groups. The intervention was implemented in 2016-2018 and included: (i) the 'all-families' component, provided to all children and their families via a school- and community-based intervention; and (ii) an additional component, the 'high-risk families' component, provided to high-risk families for diabetes as identified with a discrete manner by the FINDRISC questionnaire, which comprised seven counselling sessions (2016-2017) and a text-messaging intervention (2017-2018) delivered by trained health professionals in out-of-school settings. Although the intervention was adjusted to local needs and contextual circumstances, standardized protocols and procedures were used across all countries for the process, impact, outcome and cost-effectiveness evaluation of the intervention.
Primary schools and municipalities in six European countries.
Families (primary-school children, their parents and grandparents) were recruited from the overall population in low/middle-income countries (Bulgaria, Hungary), from low socio-economic areas in high-income countries (Belgium, Finland) and from countries under austerity measures (Greece, Spain).
The Feel4Diabetes-intervention reached 30 309 families from 236 primary schools. In total, 20 442 families were screened and 12 193 'all families' and 2230 'high-risk families' were measured at baseline.
The Feel4Diabetes-intervention is expected to provide evidence-based results and key learnings that could guide the design and scaling-up of affordable and potentially cost-effective population-based interventions for the prevention of type 2 diabetes.
•Halting the rise in childhood obesity is an ongoing challenge in Europe.•Sugar-sweetened beverage (SSB) intake has become a common family practice.•Permissive parenting was associated with a higher ...intake of SSBs in children, independent of body mass index.•Parents watching television with their children was positively associated with SSBs in normal-weight children.•Modification of permissive parenting could effectively reduce children's SSB intake.
Halting the rise in childhood obesity is an ongoing challenge in Europe. Sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption has become common practice at home and during family meals. The objective of this study was to investigate associations of parenting practices and home digital media availability with beverage intake in European schoolchildren of different weight groups.
Cross-sectional data were derived from six countries taking part in the multicentered Feel4Diabetes-study. Anthropometric data were measured for 12 030 schoolchildren (n = 6097 girls; median age = 8.1 y). Details on sociodemographic characteristics, beverage intake, food parenting practices, and home availability of digital media were collated from questionnaires. The outcomes, daily SSB and ASB intakes, were included as dependent variables in multivariable regression models that provided odds ratios reflecting their association with parenting practices and digital media (exposures), after stratifying for children's weight status (underweight or normal versus overweight or obese).
After controlling for children's sex, region, maternal body mass index, and education, the multivariate model found that in both body mass index groups, permissive parenting practices, such as rewarding and allowing consumption of unhealthy foods “very often or often,” as compared with “rarely or never,” were associated with a high daily intake of SSBs and ASBs in children, while parents “watching television together with their child,” rewarding with screen time, and availability of television in children's rooms increased the likelihood of both beverages in the underweight or normal-weight group.
Modification of permissive parenting practices and removal of television from children's rooms could effectively reduce SSB intake and curb the ongoing threat of child obesity in Europe.
•Across the globe, childhood overweight/obesity (OW/OB) is a serious health problem.•We compared factors from prenatal to mid-childhood associated with prospective BMI deterioration.•Parental OW/OB ...and country economic classification by Gross National Income were associated with higher odds of children's prospective BMI deterioration.•Public health initiatives targeting childhood obesity should prioritize European countries at high risk.
This study aimed to evaluate all known risk factors, from perinatal to adolescence and identify those predominantly related with prospective BMI deterioration.
Prospective data analysis from the European Feel4Diabetes-study involving 12,211 children from six countries. Details on perinatal and sociodemographic characteristics were collected by parental self-reported questionnaires. Children’s anthropometric data were measured by research personnel. Associations between risk factors and children’s BMI deterioration (i.e increase) from baseline (mean age 8.2 ± 0.98 years) to the 2-year follow-up (10.3 ± 1.0 years) were explored by applying logistic regression analyses.
Univariate analysis revealed that all known risk factors for early overweight/obesity development, remained dominant in prospective BMI deterioration. When multivariate analysis was applied including additional variables such as parents’ current BMI status, family socio-demographic characteristics and country economic classification based on Gross National Income, most perinatal risk factors were no longer significant. Multivariate analysis revealed that pre-pregnancy maternal overweight/obesity (OR, 95%CI: 2.71, 1.67-4.38), early introduction of solid foods (2.54, 1.21-5.31), parental current BMI status (3.53, 2.17-5.72) and country economic classification (low income: 4.67, 2.20-9.93; under austerity measures: 6.78, 3.18-14.48) were the only parameters associated with higher odds for children’s BMI deterioration from the study baseline to 2-year follow-up after adjusting for children’s gender.
The most predominant risk factors influencing children’s prospective BMI deterioration were parental BMI and country economic classification as compared to perinatal. These findings should guide public health initiatives aiming to tackle the childhood obesity epidemic and social inequalities on a European level.
The aim of this study was to develop and examine the predictive accuracy of an index that estimates obesity risk in childhood based on perinatal factors and maternal sociodemographic characteristics. ...Analysis was conducted by using cross-sectional and retrospective data collected from a European cohort of 2775 schoolchildren and their families participating in the Feel4Diabetes-study. The cohort was randomly divided by using two-thirds of the sample for the development of the index and the remaining one third for assessing its predictive accuracy. Logistic regression analyses determined a prediction model for childhood obesity. The area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated. Cut-off analysis was applied to identify the optimal value of the index score that predicts obesity with the highest possible sensitivity and specificity. Eight factors were found to be significantly associated with obesity and were included as components in the European “Childhood Obesity Risk Evaluation” (CORE) index: region of residence, maternal education, maternal pre-pregnancy weight status, gestational weight gain, maternal smoking during pregnancy, birth weight for gestational age, infant growth velocity, and exclusive breastfeeding during the first 6 months. Risk score ranged from 0 to 22 corresponding to a risk from 0.9 to 54.6%. The AUC-ROC was 0.725 with optimal cut-off ≥9 (sensitivity = 74.1%, specificity = 61.0%, PPV = 11.3%, NPV = 97.2%).
Conclusion:
The European CORE index can be used as a screening tool for the identification of infants at high-risk for becoming obese at 6–9 years. This tool could assist healthcare professionals in initiating preventive measures from the early life.
Trial registration:
The Feel4Diabetes-intervention is registered at
https://clinicaltrials.gov/
; number, CT02393872; date, March 20, 2015.
What is Known:
• As prevention of obesity should start early in life, there is a compelling rationale for the early identification of high-risk children to facilitate targeted intervention.
What is New:
• This study developed and assessed the predictive accuracy of an index for the Childhood Obesity Risk Evaluation (CORE), combining certain perinatal factors and maternal sociodemographic characteristics in a large European cohort.
• The European CORE index can be used as a screening tool for identifying infants at high-risk for becoming obese at 6–9 years and assist health professionals in initiating early prevention strategies.
In order to provide effective primary care for refugees and to develop interventions tailored to them, we must know their needs. Little is known of the health needs and experiences of recently ...arrived refugees and other migrants throughout their journey through Europe. We aimed to gain insight into their health needs, barriers in access and wishes regarding primary health care.
In the spring of 2016, we conducted a qualitative, comparative case study in seven EU countries in a centre of first arrival, two transit centres, two intermediate-stay centres and two longer-stay centres using a Participatory Learning and Action research methodology. A total of 98 refugees and 25 healthcare workers participated in 43 sessions. Transcripts and sessions reports were coded and thematically analyzed by local researchers using the same format at all sites; data were synthesized and further analyzed by two other researchers independently.
The main health problems of the participants related to war and to their harsh journey like common infections and psychological distress. They encountered important barriers in accessing healthcare: time pressure, linguistic and cultural differences and lack of continuity of care. They wish for compassionate, culturally sensitive healthcare workers and for more information on procedures and health promotion.
Health of refugees on the move in Europe is jeopardized by their bad living circumstances and barriers in access to healthcare. To address their needs, healthcare workers have to be trained in providing integrated, compassionate and cultural competent healthcare.
The aim of the present study was two-fold: Firstly, to estimate the prevalence of psychological distress among international students at a Hungarian university two years after the COVID-19 outbreak; ...and secondly, to identify its demographic and socioeconomic factors, with special regard to the students' food-security status. A cross-sectional study using a self-administered questionnaire was carried out from 27 March to 3 July 2022 among international students at the University of Debrecen. The questionnaire included information on demographic and socioeconomic characteristics, food-security status (six-item United States Department of Agriculture Food Security Survey Module (USDA-FSSM)), and psychological distress (Depression, Anxiety and Stress Scale (DASS-21)). Bivariate analysis was conducted to examine the potential associations between demographic/socioeconomic factors and psychological distress. Additionally, multiple logistic regression was employed to further analyze these associations. Of 398 participants, 42.2%, 48.7%, and 29.4% reported mild to extremely severe depression, anxiety, and stress, respectively. The ages 18-24 (AOR = 2.619; 95% CI: 1.206-5.689) and 25-29 (AOR = 2.663; 95% CI: 1.159-6.119), reporting a low perception of health status (AOR = 1.726; 95% CI: 1.081-2.755), and being food insecure (AOR = 1.984; 95% CI: 1.274-3.090) were significantly associated with depressive symptoms. Being female (AOR = 1.674; 95% CI: 1.090-2.571), reporting a low perception of health status (AOR = 1.736; 95% CI: 1.098-2.744), and being food insecure (AOR = 2.047; 95% CI: 1.327-3.157) were significantly associated with anxiety symptoms. Furthermore, being female (AOR = 1.702; 95% CI: 1.026-2.824)), living with roommates (AOR = 1.977; 95% CI: 1.075-3.635), reporting a low perception of health status (AOR = 2.840; 95% CI: 1.678-4.807), and being food insecure (AOR = 2.295; 95% CI:1.398-3.767) were significantly associated with symptoms of stress. Psychosocial programs combined with strategies to alleviate food insecurity are required to enhance international students' mental health and well-being.
•Prevention of children being overweight or obese is of utmost importance. Since parental characteristics play a pivotal role in shaping offspring weight status, we examined associations between ...parental obesity and children being overweight or obese and whether other parental type 2 diabetes (T2D) risk factors can predict children's obesity.•After adjusting for all other Finnish Diabetes Risk Score (FINDRISC) variables, region and maternal/parental education, obesity, high waist circumference, and high FINDRISC score were associated with child overweight/obesity. Maternal and paternal body mass index (BMI) were the most accurate in predicting child overweight/obesity.•Among parental risk factors for T2D, maternal and parental overweight or obesity status, central obesity, and high FINDRISC score were the main predictors of childhood overweight/obesity status, with BMI the most accurate. Maternal or paternal BMI is simple to use, might be useful for the early identification of children at risk of being overweight and obese rather than other T2D factors.
The prevention of children being overweight/obese is of utmost importance. Parental characteristics play a pivotal role in shaping offspring weight status. This study aimed to examine associations between parental obesity and children's overweight/obesity status, and whether other parental type 2 diabetes (T2D) risk factors can predict children's obesity status.
Logistic regression and receiver operating characteristic (ROC) analyses were conducted, using cross-sectional data from a European cohort of 20 151 adults (10 967 mothers; 9184 fathers) and children (n = 10 967) participating in the Feel4Diabetes study. Anthropometric measurements were conducted in children, and overweight/obesity was defined according to the International Obesity Task Force criteria. Parents’ T2D risk was assessed applying the Finnish Diabetes Risk Score (FINDRISC).
After adjusting for all other FINDRISC variables, region and maternal/parental education, maternal (adjusted odds ratio aOR: 2.64; 95% confidence interval CI, 2.18–3.20) and parental (aOR: 3.21; 95% CI, 2.65–3.91) obesity, maternal (aOR: 1.46; 95% CI, 1.23–1.74) and parental (aOR: 1.59; 95% CI, 1.32–1.92) high waist circumference, as well as maternal (aOR: 1.60; 95% CI, 1.27–2.01) and parental (aOR: 1.87; 95% CI, 1.58–2.21) high FINDRISC score, were associated with child overweight/obesity status. Maternal (area under the curve– ROC: 0.638; 95% CI, 0.628–0.647) and paternal body mass index (BMI; area under the curve–ROC: 0.632; 95% CI, 0.622–0.642) were the most accurate in predicting child overweight/obesity status.
Among parental risk factors for T2D, maternal/parental overweight/obesity status, central obesity, and high FINDRISC score were the main predictors of childhood overweight/obesity status, with BMI the most accurate. Maternal or paternal BMI is simple to use, and might be useful for the early identification of children at risk of being overweight/obese rather than other T2D factors.
This study aimed to investigate the mediating role of food parenting practices (FPP), including home availability of different types of foods and drinks, parental modelling of fruit intake, ...permissiveness and the use of food as a reward in the relationship between parental education and dietary intake in European children.
Single mediation analyses were conducted to explore whether FPP explain associations between parents' educational level and children's dietary intake measured by a parent-reported FFQ.
Six European countries.
Parent-child dyads (
6705, 50·7 % girls, 88·8 % mothers) from the Feel4Diabetes-study.
Children aged 8·15 ± 0·96 years were included. Parental education was associated with children's higher intake of water, fruits and vegetables and lower intake of sugar-rich foods and savoury snacks. All FPP explained the associations between parental education and dietary intake to a greater or lesser extent. Specifically, home availability of soft drinks explained 59·3 % of the association between parental education and sugar-rich food intake. Home availability of fruits and vegetables was the strongest mediators in the association between parental education and fruit and vegetable consumption (77·3 % and 51·5 %, respectively). Regarding savoury snacks, home availability of salty snacks and soft drinks was the strongest mediators (27·6 % and 20·8 %, respectively).
FPP mediate the associations between parental education and children's dietary intake. This study highlights the importance of addressing FPP in future interventions targeting low-educated populations.
To examine the parental food consumption and diet quality and its associations with children's consumption in families at high risk for developing type 2 diabetes mellitus across Europe. Also, to ...compare food frequency consumption among parents and children from high-risk families to the European Dietary guidelines/recommendations.
Cross-sectional study using Feel4diabetes FFQ.
Families completed FFQ and anthropometric measures were obtained. Linear regression analyses were applied to investigate the relations between parental food consumption and diet quality and their children's food consumption after consideration of potential confounders.
2095 European families (74·6 % mothers, 50·9 % girls). The participants included parent and one child, aged 6-8 years.
Parental food consumption was significantly associated with children's intake from the same food groups among boys and girls. Most parents and children showed under-consumption of healthy foods according to the European Dietary Guidelines. Parental diet quality was positively associated with children's intake of 'fruit' (boys:
= 0·233,
< 0·001; girls:
= 0·134,
< 0·05) and 'vegetables' (boys:
= 0·177,
< 0·01; girls:
= 0·234,
< 0·001) and inversely associated with their 'snacks' consumption (boys:
= -0·143,
< 0·05; girls:
= -0·186,
< 0·01).
The present study suggests an association between parental food consumption and diet quality and children's food intake. More in-depth studies and lifestyle interventions that include both parents and children are therefore recommended for future research.
Background
Parental influences on children's eating and physical activity (PA) and consequently on their weight are fundamental. The present study aimed to identify the predominant correlates of ...childhood overweight/obesity among a variety of parental practices and children's lifestyle indices in a large sample of children in Europe.
Methods
Families from low socio‐economic status regions were recruited through schools, located in six European countries (Belgium, Finland, Greece, Spain, Bulgaria and Hungary). Seven thousand three hundred ninety‐seven children 4–12 years old and their parents were selected using the FINDRISC‐questionnaire. Parental practices assessed included parental role modelling, permissiveness and reward. Children's dietary intake and lifestyle behaviours were assessed through parent‐reported questionnaires.
Results
Regarding parental practices, it was revealed that being sometimes (odds ratio OR = 1.26; 95% confidence interval CI = 1.10–1.43) or rarely (OR = 1.43; 95% CI = 1.21–1.69) physically active with the child was associated with greater overweight/obesity risk, whereas rare permission of computer/mobile/tablet (OR = 0.81; 95% CI = 0.67–0.98) and sometimes (OR = 0.77; 95% CI = 0.68–0.88) or rare (OR = 0.77; 95% CI = 0.66–0.91) reward with PA were associated with lower risk. Regarding children's lifestyle factors, consuming > 3 cups/week fresh fruit juices (OR = 1.28; 95% CI = 1.13–1.45), skipping breakfast (OR = 1.37; 95% CI = 1.17–1.61), absence of 1 h of daily PA (OR = 1.40; 95% CI = 1.24–1.58) and increased daily screen time (ST) (OR = 1.23; 95% CI = 1.09–1.39) were associated with greater overweight/obesity risk. All the variables were adjusted for maternal education, child's sex and age.
Conclusions
These findings emphasize the necessity of family‐centered approaches in health promotion and obesity prevention programs for children. Such programs should focus on parents as the primary role models in exerting positive influence and encouraging healthy eating habits, PA, and ST behaviors in their children, which in turn, may have a substantial impact on children's overall weight status.
The adoption of a physically active lifestyle with the child, with limited screen‐time permission, rare reward with physical activity and healthy eating habits are associated with lower childhood overweight/obesity risk. Future health actions could be orchestrated aiming to counteract childhood overweight/obesity by involving parents as an integral component of any obesity program.
Key points
Being physically active with the child is associated with reduced obesity risk
Omission of breakfast and high fresh fruit juices consumption may increase childhood obesity risk
Parental control on children's screen time is linked with lower childhood obesity risk
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